Vascular endothelium, a promising target for effectively treating fulminant diquat intoxication?

Abstract

Following the withdrawal of paraquat, diquat (DQ) has emerged as the predominant herbicide. When people come into contact with or ingest DQ, may lead to poisoning and potentially fatal outcomes. Reports suggest that the mortality of DQ poisoning can be as high as 50%. DQ poisoning can be categorized as mild, moderate to severe or fulminant. In cases of fulminant poisoning, victims often succumb to multiple organ failure within 48 h. This presents a significant challenge in the clinical management. Scholars have discovered that oxidative stress, inflammatory injury, and cell apoptosis play crucial roles in the DQ poisoning. However, the underlying connection of the extensive organ damage remains unknown. The abnormal function and activity of endothelial cells (EC) should play a crucial role in tissue damage caused by DQ due to rich microcirculation and high sensitivity to perfusion in the vulnerable organs. However, reports on DQ-induced EC injury is rare. We made a preliminary discovery-the presence of severe vascular endothelial damage in the kidneys and lungs affected by DQ. Therefore, we hypothesize that DQ poisoning may be attributed to EC damage, ultimately resulting in multiple organ failure.

Keywords: Diquat poisoning; Endothelial cells; Multiple organ dysfunction syndrome; Treatment; Oxidative stress

Core Tip: Based on our team's extensive experience and accumulated evidence in treating fulminant diquat (DQ) intoxication, we believe that endothelial cell injury plays a crucial role in the organ damage caused by DQ poisoning. However, there is currently a lack of reports on the role of endothelial cell injury in the development of multiple organ dysfunction syndrome induced by fulminant DQ poisoning. Some studies have observed vascular endothelium injury after DQ poisoning, but vascular endothelial cell is not the main focus of these studies.